Should we combine manual therapy and exercise for neck pain?

Male chiropractor manipulating a young female patient's neck

Low back and neck pain, when combined, account for much of the individual disability and tremendous healthcare expenditure globally. It is therefore necessary to continually evaluate the effective management and treatment of patients with nonspecific spinal pain conditions.
Nonspecific neck pain typically develops gradually and may be caused by a variety of factors which often occur in combination, such as: poor posture, anxiety, depression, strain, and various (athletic or occupational) activities. Clinical practice guidelines for neck pain treatment recommend a multimodal approach that includes exercise, manual therapy, and other interventions. However, it is difficult to determine which intervention is best to use in different types of neck pain patients because interventions in RCTs are often provided in combination and the makeup of included groups are dissimilar.
A common treatment used for patients with nonspecific neck pain is manual therapy using mobilization and/or manipulation techniques, very often in combination with exercise. Nonetheless, numerous studies have investigated manual therapy and exercise interventions in isolation.
The objective of this current review was to systematically review and perform a meta-analysis to determine the effect of manual therapy combined with exercise on pain and disability in individuals with nonspecific neck pain.

Comment from Dr. Thistle:

“Even though parts of this analysis suggest that adding exercise to manual therapy is not statistically better than manual therapy alone – let me pose a (perhaps rhetorical) question:  Is there a downside to combining manual therapy with exercise? In most cases, probably not. In your practice, adding simple rehabilitation to your neck pain treatment regimen will likely help your patients and may even help them reduce the frequency and/or severity of subsequent episodes (as we know, most patients with neck or back pain have an episodic pattern). I also think the addition of rehab or exercise engages the patient in their own care, something that has also been shown to improve outcomes!“

RESEARCH REVIEW: Combining Manual Therapy and Exercise for Nonspecific Neck Pain

This paper was published in JMMT 2023

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